May 2019

The Difference Between a Nursing Home Facility and an Assisted Living Facility

The real difference between a nursing facility and an assisted living facility in Virginia is a licensing difference. Nursing facilities are licensed by the Department of Health while Assisted Living facilities are licensed by the Department of Social Services. Nursing facilities are medical institutions. They must have a medical director (physician) and a have full time nurse. Medicaid will pay a nursing home for health care related services including room and board. Because it's not licensed as a health care facility Medicaid will not pay for assisted living care. In realty the care in the assisted living facility may be exactly the same care in the nursing home facility including help with activities of daily living; medication administration and other daily life care needs. Both facilities have care aides that provide the bulk of the care.

There is a huge marketing difference between the two types of institutions. Given that nursing facilities look like medical institutions, assisted living facilities market to individuals who wish to transition to a place that looks more like an apartment or even a resort. In this way, assisted living facilities have become the more dominate form of assisted care. Because the return in the sale of home in the northern Virginia area can be great, plus the steady and more generous retirement income from federal services, the monthly cost of an assisted living facility is within reach of many middle income older adults in the northern Virginia area. Assisted living facilities have moved in to cater to this need of assisted care but in a much more home like setting with all the accommodations of a resort such as exercise classes, outings; fancier meal services etc. There is only a limited public benefit resource paid by Virginia for assisted living called an 'Auxiliary Grant'. Because eligibility is so strict and payment to the assisted living facility so low, availability of this benefit is very limited.

Skilled nursing rehabilitative therapy under Medicare is only provided in a licensed nursing facility. When this short term Medicare coverage ends, and the person needs 24/7 care, the question of where they will go is a matter of finance. If the person is unable to return home then the option is custodial care in a nursing facility or custodial care in assisted living. If the person has limited resources then with a short spenddown, they will qualify for Medicaid coverage in a nursing home. If they have greater resources, then the more 'luxurious' setting of assisted living may be more preferable.

Whatever the circumstances individuals and families need to understand how our system of long-term care works.

Edward Zetlin Law is experienced in Elder Law and Special Needs Planning issues. Don't hesitate to call if you face such an issue or if you have additional questions. Edward Zetlin Law would be happy to discuss. Please contact us at 703-379-0442 or e-mail at

Community Presentations in May 2019. Alzheimer's Support Group May 9 at 7:00 pm at the Aldersgate Church, 1301 Collingwood Road, Alexandria, VA; Alzheimer's & Dementia Support Group May 15 at 10:30 am 601 S. Carlin Springs Road, Arlington, VA & at St. Coletta of Greater Washington, May 18 at 1:30pm Transition Training. St. Coletta is located at 1901 Independence Ave. SE, Washington DC.

Contact us at (703)379-0442;

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